Casablanca Registration Form

for Casablanca Users in the Americas Only!

Date:

Suffix:

Mr. Ms. Mrs. Dr.

First Name:*

Last Name:*

Company/School/Church

Street:*

City:*

State/Province:*

Zip Code:*

Email Address:*

Phone Number:

Fax:

Your Age Group:

18-34 35-49 over 50

Video related magazines you read (check all that apply):

AV Video
Government Video
Videomaker
Camcorder and Computer Video
TV Technology
WEVA
DV
Videography
other

About Your Casablanca Model

Serial Number (from the back of the unit)*

Purchase Date:

Software Version:

Casablanca Dealer:

Salesperson:

Dealer Location:

How was your sales/service experience?

How did you hear about Casablanca?

What do you think of your Casablanca?

May we use your comments for promotional purposes?

Yes No

About Your Business

Primary Business at your location:

Number of Employees:

How will you use your Casablanca?

Type of Videography Business (please check all that apply)

Commercial
Wedding
Post Production
Event
Training

Please check one only if none of the above apply to you.

Home
Wholesale/Manufacturing
Broadcast or Cable
School
Retail/Service
Religious Organization
Advertising
Government
Corporate Training Videos

Other: